Medicines optimisation: new good practice guide

New good practice guidance for medicines optimisation has been launched today by the Royal Pharmaceutical Society (RPS). It is endorsed by NHS England, medical Royal Colleges and the Association of the British Pharmaceutical Industry (ABPI).

The document sets out four guiding principles to help front-line healthcare professionals in England support patients improve their quality of life and outcomes from better use of medicines, which cost the NHS in England £13.8 billion each year.

The principles, which have been developed with health professionals, patients, lay representatives and patient groups, call on professionals to: - aim to understand the patient's experience; - make sure choice of medicine is made on the best available evidence; - ensure medicines use is as safe as possible; and - make medicines optimisation part of routine practice.

These "simple but important" principles could revolutionise medicines use and outcomes, according to a foreword to the guidance signed by Sir Bruce Keogh, national medical director at NHS England, chief nursing officer for England Jane Cummings and Dr Keith Ridge, the chief pharmaceutical officer.

The RPS reports that only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need, and that 10 days after starting a medicine, almost a third are already non-adherent. It also notes that the value of medicines wasted in primary care in England each year is conservatively estimated at at least £300 million, of which half is avoidable, and that the cost to the NHS in patient benefits lost through people not taking their prescribed/dispensed benefits in line with recommended advice is put at £0.5 billion annually.

Medicines use today is too often sub-optimal, and medicines optimisation represents the step-change which is needed in the way that all healthcare professionals support patients to get the best possible outcomes from their medicines. This will require multidisciplinary team working to an extent that has not been seen previously, to individualise care, monitor outcomes more carefully, review medicines more frequently and support patients when needed, says the guidance.

It also points out that medicines optimisation differs from medicines management in a number of ways but, most importantly, it focuses on outcomes and patients rather than process and systems. This is likely to help ensure that patients and the NHS get better value from the investment in medicines, it notes.

"The pharmaceutical industry also has a key role to play in medicines optimisation through transparent and value-for-money partnerships with the NHS that help secure better outcomes for patients," it adds.

"An estimated 30%-50% of patients don't take their medicines as prescribed and this situation can no longer continue. The ill-health, poor quality of life, loss of productivity and waste of NHS resources that results is simply unacceptable," said RPS president Martin Astbury, commenting as the guidance was launched.

And in their foreword, Sir Bruce, Ms Cummings and Dr Ridge write: “given that medicines remain the most common therapeutic intervention in healthcare, and colleagues in research and the broad pharmaceutical industry have worked hard to discover and develop safe and effective medicines, we must all work even harder together to ensure that individual patients and society gets as much value out of that effort as possible, and resources are used wisely and effectively."

- The guidance is endorsed by NHS England, the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN), the Academy of Medical Royal Colleges and the ABPI.